scholarly journals Virtual echocardiography screening tool to differentiate hemodynamic profiles in pulmonary hypertension

2020 ◽  
Vol 10 (3) ◽  
pp. 204589402095022
Author(s):  
Anjali Vaidya ◽  
Jessica R. Golbus ◽  
Natasha A. Vedage ◽  
Jeremy Mazurek ◽  
Farhan Raza ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Screening Tool ◽  
Systolic Pressure ◽  
Area Under The Curve ◽  
Right Heart Catheterization ◽  
Discriminatory Power ◽  
Pulmonary Vascular Disease ◽  
Heart Catheterization ◽  
Right Heart ◽  
Tertiary Center

This study validated a novel virtual echocardiography screening tool (VEST), which utilized routinely reported echocardiography parameters to predict hemodynamic profiles in pulmonary hypertension (PH) and identify PH due to pulmonary vascular disease (PHPVD). Direct echocardiography imaging review has been shown to predict hemodynamic profiles in PH; however, routine use often overemphasizes Doppler-estimated pulmonary artery systolic pressure (PASPDE), which lacks discriminatory power among hemodynamically varied PH subgroups. In patients with PH of varying subtypes at a tertiary referral center, reported echocardiographic findings needed for VEST, including left atrial size, E:e’ and systolic interventricular septal flattening, were obtained. Receiver operating characteristic analyses assessed the predictive performance of VEST vs. PASPDE in identifying PHPVD, which was later confirmed by right heart catheterization. VEST demonstrated far superior discriminatory power than PASPDE in identifying PHPVD. A positive score was 80.0% sensitive and 75.6% specific for PHPVD with an area under the curve of 0.81. PASPDE exhibited poorer discriminatory power with an area under the curve of 0.56. VEST’s strong discriminatory ability remained unchanged when validated in a second cohort from another tertiary center. We demonstrated that this novel VEST using three routine parameters that can be easily extracted from standard echocardiographic reports can successfully capture PH patients with a high likelihood of PHPVD. During the Covid-19 pandemic, when right heart catheterization and timely access to experts at accredited PH centers may have limited widespread availability, this may assist physicians to rapidly and remotely evaluate PH patients to ensure timely and appropriate care.

scholarly journals Preoperative Evaluation of Pulmonary Hypertension in Lung Transplant Candidates: Echocardiography Versus Right Heart Catheterization

2021 ◽  
Author(s):  
Tal Abu ◽  
Amos Levi ◽  
David Hasdai ◽  
Mordechai R. Kramer ◽  
Tamir Bental ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Pulmonary Artery ◽  
Preoperative Evaluation ◽  
Systolic Pressure ◽  
Area Under The Curve ◽  
Right Heart Catheterization ◽  
Mean Value ◽  
Pulmonary Artery Systolic Pressure ◽  
Heart Catheterization ◽  
Right Heart

Abstract Background - Right heart catheterization (RHC) and echocardiography are both routinely used for pulmonary artery systolic pressure (PASP) assessment in lung transplantation (LT) candidates, although this is not mandated by current guidelines. We aimed to explore the correlation between PASP estimated by echocardiography to that measured by RHC, in this population in order to assess the necessity of RHC. Methods - From a retrospective registry of 393 LT candidates undergoing RHC and echocardiography during 2015-2019, patients were assessed for the presence of pulmonary hypertension (PH), defined as mean pulmonary artery pressure (mPAP) above 20 mmHg, according to two methods – echocardiography and RHC. The primary outcome was the correlation between the PASP estimated by echocardiography to that measured by RHC. Secondary outcomes were the prediction value of the echocardiographic evaluation and its accuracy. Results - The mean value of PASP estimated by echocardiography was 49.5±20.0 mmHg, compared to 42.5±18.0 mmHg measured by RHC. The correlation between the two measurements was moderate (Pearson’s correlation: r=0.609, p<0.01). Echocardiography PASP measurements were moderately discriminative to diagnose PH, with an area under the curve (AUC) of 0.72 (95% CI 0.66-0.76). Echocardiographic overestimation of PASP of more than 10 mmHg was found in 35.0% of the patients, and underestimation was found in 11.6% of the patients.Conclusion - In the pre-surgical evaluation of LT candidates, echocardiographic estimation of PASP had moderate correlation and limited accuracy compared to the PASP measured by RHC. We thus recommend performing routine RHC to all LT candidates, regardless of the echocardiographic estimation of PASP.

scholarly journals Comprehensive Diagnostic Evaluation of Cardiovascular Physiology in Patients With Pulmonary Vascular Disease

2020 ◽  
Vol 13 (3) ◽  
Author(s):  
W. H. Wilson Tang ◽  
Jennifer D. Wilcox ◽  
Miriam S. Jacob ◽  
Erika B. Rosenzweig ◽  
Barry A. Borlaug ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Vascular Disease ◽  
Cardiopulmonary Exercise Test ◽  
Right Heart Catheterization ◽  
Repeated Measurements ◽  
Pulmonary Vascular Disease ◽  
Heart Catheterization ◽  
Right Heart ◽  
Unique Identifier ◽  
Hemodynamic Evaluation

Background: Invasive hemodynamic evaluation through right heart catheterization plays an essential role in the diagnosis, categorization, and risk stratification of patients with pulmonary hypertension. Methods: Subjects enrolled in the PVDOMICS (Redefining Pulmonary Hypertension through Pulmonary Vascular Disease Phenomics) program undergo an extensive invasive hemodynamic evaluation that includes repeated measurements at rest and during several provocative physiological challenges. It is a National Institutes of Health/National Heart, Lung, and Blood Institute initiative to reclassify pulmonary hypertension groups based on clustered phenotypic and phenomic characteristics. At a subset of centers, participants also undergo an invasive cardiopulmonary exercise test to assess changes in hemodynamics and gas exchange during exercise. Conclusions: When coupled with other physiological testing and blood -omic analyses involved in the PVDOMICS study, the comprehensive right heart catheterization protocol described here holds promise to clarify the diagnosis and clustering of pulmonary hypertension patients into cohorts beyond the traditional 5 World Symposium on Pulmonary Hypertension groups. This article will describe the methods applied for invasive hemodynamic characterization in the PVDOMICS program. Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT02980887.

Echocardiographic probability of pulmonary hypertension: a validation study

2022 ◽  
pp. 2102548
Author(s):  
Michele D'Alto ◽  
Marco Di Maio ◽  
Emanuele Romeo ◽  
Paola Argiento ◽  
Ettore Blasi ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Right Heart Catheterization ◽  
Right Atrial ◽  
Pulmonary Vascular Disease ◽  
Heart Catheterization ◽  
Right Heart ◽  
Basal Diameter ◽  
Acceleration Time ◽  
Eccentricity Index ◽  
Current Guidelines

BackgroundAccording to current guidelines, the diagnosis of pulmonary hypertension (PH) relies on echocardiographic probability followed by right heart catheterization. How echocardiography predicts PH recently re-defined by a mean pulmonary artery pressure (mPAP) >20 mmHg instead of ≥25 mmHg and pulmonary vascular disease defined by a pulmonary vascular resistance (PVR) >3 or >2 Wood units has not been established.MethodsA total of 278 patients referred for PH underwent a comprehensive echocardiography followed by a right heart catheterization. Fifteen patients (5.4%) were excluded because of insufficient quality echocardiography.ResultsWith PH defined by a mPAP >20 mmHg, 23 patients had no PH, 146 had pre-capillary and 94 post-capillary PH. At univariate analysis, maximum velocity of tricuspid regurgitation (TRV) ≥2.9 and ≤3.4 m s−1, left ventricle (LV) eccentricity index >1.1, right ventricle (RV) outflow tract (OT) notching or acceleration time <105 ms, RV-LV basal diameter >1 and PA diameter predicted PH, whereas inferior vena cava diameter and right atrial area did not. At multivariable analysis, only TRV ≥2.9 m s−1 independently predicted PH. Additional independent prediction of PVR >3 Wood units was offered by LV eccentricity index >1.1 and RVOT acceleration time <105 ms and/or notching, but with no improvement of optimal combination of specificity and sensibility or positive prediction.ConclusionsEchocardiography as recommended in current guidelines can be used to assess the probability of re-defined PH in a referral center. However, the added value of indirect signs is modest and sufficient quality echocardiographic signals may not be recovered in some patients.

P193 The value of 12-lead electrocardiogram in secundum atrial defect with pulmonary hypertension

2020 ◽  
Vol 41 (Supplement_1) ◽  
Author(s):  
J O S Santoso ◽  
R P Prakoso ◽  
R S Simamora ◽  
H S M Muliawan ◽  
B B S Siswanto
Keyword(s):  
Pulmonary Hypertension ◽  
High Resistance ◽  
Predictive Value ◽  
Right Heart Catheterization ◽  
Low Flow ◽  
Pulmonary Vascular Disease ◽  
Heart Catheterization ◽  
Axis Deviation ◽  
Right Heart ◽  
Cross Sectional

Abstract Background Pulmonary hypertension is a serious complication that can develop in patients with secundum Atrial Septal Defect (ASD) and based on Euro Heart Survey, 24,77% of ASD patients develop PH. The gold-standard for the diagnosis of pulmonary hypertension in ASD is right heart catheterization. However, in low-middle income country like Indonesia, right heart catheterization only available in a few centers while Indonesia is often referred as the world’s largest archipelago. Thus, there is a huge number of undiagnosed and untreated patients with ASD-PH in Indonesia, especially in patients who lives in rural and isolated area. This research was initiated to investigate the diagnostic value of simple 12-lead ECG in the diagnosis of pulmonary hypertension in ASD with the intention to help doctors in isolated area. Method We performed a cross-sectional study analyzing the 12-lead ECG and mean arterial pressure collected from right heart catheterization from 120 patients with secundum ASD aged &gt; 18 years old. The 12-lead ECG collected within 24 hours before RHC procedure. Results We analyzed the ECG and RHC from 60 subjects diagnosed with pulmonary hypertension and 60 subjects without pulmonary hypertension. We found that R in lead V1 + S in lead V6&gt; 12,5 mV, right axis deviation (RAD), and RV strain were independent predictors of pulmonary hypertension in secundum ASD. Based on Receiver Operator Characteristics (ROC), we obtained that R in V1 + S in V6&gt; 12,5 mm, right axis deviation (RAD), and RV strain has an Area Under of Curve (AUC) of 80,8%, 70,5%, and 85,6% respectively. We developed a scoring system and a score of &gt;5 have a sensitivity of 90%, specificity of 84,4%, positive predictive value of 84,4%, negative predictive value of 90%, and accuracy of 87,1%. We also developed a predictor for pulmonary vascular disease (low flow and high resistance PH) to predict wether the defect can be closed. We obtained that R in V6 + S in V6 &gt; 27,5 mm can predict a low flow high resistance pulmonary hypertension in secundum ASD with an AUC of 77,1% (CI 95% 58-96,1%) Conclusion ECG score of 12-lead ECG derived from this study can be used to predict PH in secundum ASD. It may help cardiologists or general practitioners in rural and isolated area to diagnose pulmonary hypertension in ASD and plan the best management for the patients.

scholarly journals Pulmonary hypertension in patients with chronic kidney disease: invasive hemodynamic etiology and outcomes

2017 ◽  
Vol 7 (3) ◽  
pp. 674-683 ◽  
Author(s):  
Jared M. O’Leary ◽  
Tufik R. Assad ◽  
Meng Xu ◽  
Kelly A. Birdwell ◽  
Eric Farber-Eger ◽  
...  
Keyword(s):  
Risk Factors ◽  
Chronic Kidney Disease ◽  
Pulmonary Hypertension ◽  
Kidney Disease ◽  
Right Heart Catheterization ◽  
Pulmonary Vascular Disease ◽  
Heart Catheterization ◽  
Right Heart ◽  
Related Risk ◽  
Co Morbidity

Pulmonary hypertension (PH) is common in patients with chronic kidney disease (CKD) and associated with increased mortality but the hemodynamic profiles, clinical risk factors, and outcomes have not been well characterized. Our objective was to define the hemodynamic profile and related risk factors for PH in CKD patients. We extracted clinical and hemodynamic data from Vanderbilt’s de-identified electronic medical record on all patients undergoing right heart catheterization during 1998–2014. CKD (stages III–V) was defined by estimated glomerular filtration rate thresholds. PH was defined as mean pulmonary pressure ≥ 25 mmHg and categorized into pre-capillary and post-capillary according to consensus recommendations. In total, 4635 patients underwent catheterization: 1873 (40%) had CKD; 1518 (33%) stage 3, 230 (5%) stage 4, and 125 (3%) stage 5. PH was present in 1267 (68%) of these patients. Post-capillary (n = 965, 76%) was the predominant PH phenotype among CKD patients versus 302 (24%) for pre-capillary ( P < 0.001). CKD was independently associated with pulmonary hypertension (odds ratio = 1.4, 95% confidence interval = 1.18–1.65). Mortality among CKD patients rose with worsening stage and was significantly increased by PH status. PH is common and independently associated with mortality among CKD patients referred for right heart catheterization. Post-capillary was the most common etiology of PH. These data suggest that PH is an important prognostic co-morbidity among CKD patients and that CKD itself may have a role in the development of pulmonary vascular disease in some patients.

scholarly journals Preoperative evaluation of pulmonary hypertension in lung transplant candidates: echocardiography versus right heart catheterization

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
K Skalsky ◽  
T Abu ◽  
A Levi ◽  
T Bental ◽  
R Hirsh ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Preoperative Evaluation ◽  
Systolic Pressure ◽  
Right Heart Catheterization ◽  
Mean Value ◽  
Secondary Outcome ◽  
Pulmonary Artery Systolic Pressure ◽  
Chronic Obstructive ◽  
Heart Catheterization ◽  
Right Heart

Abstract Background Right heart catheterization (RHC) and echocardiography are both routinely used for pulmonary hypertension (PH) assessment in LT candidates, although this is not mandatory according to guidelines. We aim to describe the correlation between the pulmonary artery systolic pressure (PASP) measured by echocardiography to that measured by RHC in this population. Methods From a retrospective registry of 461 LT candidates, undergoing RHC between 2015–2019, 393 consecutive patients were assessed for the presence of pulmonary hypertension according to two methods – echocardiography and RHC. The primary outcome was the correlation between the estimated PASP measured by echocardiography to that measured by RHC. Secondary outcome was the accuracy of the echocardiographic assessment of PH. Results Patients were predominantly males (63.6%) with a mean age of 61.46±8.33y. The two most common etiologies for lung failure were interstitial lung disease or pulmonary fibrosis (52.2%) and chronic obstructive pulmonary disease (30.5%). Estimated PASP as measured by echocardiography was available in 89.31% of the patients, with a mean value of 49.5±20.02 mmHg. Mean PASP measured by RHC was 42.47±17.96 mmHg. The correlation between the two measurements was moderate (Pearson's correlation: r=0.609, p&lt;0.01). The accuracy of the echocardiographic estimation of PASP was poor with &gt;10 mmHg differences between the two values in 79.9% of the patients. Conclusions In the pre-surgical evaluation of LT candidates, echocardiographic estimation of PASP has moderate correlation with the PASP measured by RHC and relatively poor accuracy. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Right heart catheterization procedures in patients with suspicion of pulmonary hypertension – experiences of a tertiary center

2017 ◽  
Vol 4 ◽  
pp. 295-301
Author(s):  
Maciej Grymuza ◽  
Katarzyna Małaczyńska-Rajpold ◽  
Stanisław Jankiewicz ◽  
Andrzej Siniawski ◽  
Marek Grygier ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Right Heart Catheterization ◽  
Heart Catheterization ◽  
Right Heart ◽  
Tertiary Center

scholarly journals The Accuracy and Influencing Factors of Doppler Echocardiography in Estimating Pulmonary Artery Systolic Pressure: Comparison With Right Heart Catheterization : A Retrospective Cross-sectional Study

2021 ◽  
Author(s):  
Guangjie Lv ◽  
Aili Li ◽  
Xincao Tao ◽  
Yanan Zhai ◽  
Yu Zhang ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Regression Analysis ◽  
Influencing Factors ◽  
Systolic Pressure ◽  
Right Heart Catheterization ◽  
Pulmonary Artery Systolic Pressure ◽  
Heart Catheterization ◽  
Signal Quality ◽  
Right Heart ◽  
Ordinal Regression Analysis

Abstract Background: Noninvasive assessment of pulmonary artery systolic pressure by Doppler echocardiography (sPAPECHO) has been widely adopted to screen for pulmonary hypertension (PH). But high proportion of overestimation or underestimation of sPAPECHO still remained. So we aimed to explore the accuracy and influencing factors of sPAPECHO with right heart catheterization (RHC) as reference. Methods: A total of 218 highly suspected pulmonary hypertension (PH) patients who underwent RHC and echocardiography within 7 days were included. The correlation and consistency between tricuspid regurgitation (TR) derived parameters and RHC results were tested by Pearson and Bland-Altaman methods. With mPAP ≥25mmHg measured by RHC as the standard diagnostic criteria of PH, ROC curve was used to compared the diagnostic efficacy of sPAPECHO with other TR related methods. The ratio of (sPAPECHO-sPAPRHC)/sPAPRHC was calculated and divided into three groups, namely, the underestimation group, accurate group and overestimation group by ±10% as the boundary. The influencing factors of sPAPECHO were analyzed by ordinal regression analysis.Results: sPAPECHO had the greatest correlation coefficient (r=0.781, P<0.001), best diagnostic efficiency (AUC=0.98) and lowest bias (mean bias= 0.07mmHg, 95% limits of agreement: -32.08 to +32.22mmHg) compared with other TR related methods. Ordinal regression analysis showed that TR signal quality, PAWP and sPAPRHC level affected the accuracy of sPAPECHO (P < 0.05). The OR value of PAWP was 0.94 (95%CI: 0.89, 0.99). Compared with high sPAPRHC level, the OR value of low and medium sPAPRHC level were 21.56 (95%CI: 9.57, 48.55) and 5.13 (95%CI: 2.55, 10.32) , respectively. Relative to the signal quality of type A, the OR value of type B and C signal quality were 0.26 (95%CI: 0.14, 0.48) and 0.23 (95%CI: 0.07, 0.73), respectively. While TR severity and right ventricular systolic function had no significant effect on the accuracy of sPAPECHO. Conclusions: sPAPECHO was superior to other TR-related methods in PH screening, and was often overestimated in patients with pre-capillary PH at low sPAPRHC level, even with good TR signal quality.Trial registration: This is a retrospectively registered study.

scholarly journals Right Heart Size and Right Ventricular Reserve in Pulmonary Hypertension: Impact on Management and Prognosis

Diagnostics ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. 1110
Author(s):  
Ekkehard Grünig ◽  
Christina A. Eichstaedt ◽  
Rebekka Seeger ◽  
Nicola Benjamin
Keyword(s):  
Pulmonary Hypertension ◽  
Right Ventricular ◽  
Ventricular Function ◽  
Right Ventricular Function ◽  
Right Heart Failure ◽  
Right Heart Catheterization ◽  
Contractile Reserve ◽  
Heart Catheterization ◽  
Right Heart ◽  
Heart Size

Various parameters reflecting right heart size, right ventricular function and capacitance have been shown to be prognostically important in patients with pulmonary hypertension (PH). In the advanced disease, patients suffer from right heart failure, which is a main reason for an impaired prognosis. Right heart size has shown to be associated with right ventricular function and reserve and is correlated with prognosis in patients with PH. Right ventricular reserve, defined as the ability of the ventricle to adjust to exercise or pharmacologic stress, is expressed by various parameters, which may be determined invasively by right heart catheterization or by stress-Doppler-echocardiography as a noninvasive approach. As the term “right ventricular contractile reserve” may be misleading, “right ventricular output reserve” seems desirable as a preferred term of increase in cardiac output during exercise. Both right heart size and right ventricular reserve have been shown to be of prognostic importance and may therefore be useful for risk assessment in patients with pulmonary hypertension. In this article we aim to display different aspects of right heart size and right ventricular reserve and their prognostic role in PH.

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